肿瘤临床诊断研究培训课件.ppt

肿瘤临床诊断研究;● Cecum ● Ascending Colon ● Transverse Colon ● Descending Colon ● Sigmoid Colon ● Rectum;● 12 ~ 15 cm ● peritoneal portion and pelvis portion ● mesorectum ;● common tumor in gastrointe- stinal tract ● occur mostly at 41~65 years old ● colon cancer seems more and more in recent 20 years ● proliferation—adenoma --carcinoma, about 10~15 years;PATHOLOGY ;MASS TYPE;INVASIVE TYPE;ULCERATIVE TYPE;HISTOLOGIC CLASSIFICATION;Normal epithelium;HIGH RISK FACTORS;adenoma;CEA (carcinoembryonic antigen) An important marker for colorectal cancer (expressed in 60% of patients);EXTENDING ROUTES OF COLORECTAL CANCER;LYMPHATIC METASTASIS;PATHOLOGIC STAGING;Dukes Staging;TNM Staging 2009年UICC第九版分期;TNM Staging;HIGH-RISK PATIENTS ;CARCINOMA OF COLON;CLINICAL FEATURES ; Differences of Colon Cancer in Ascending with in descending;IMAGING STUDIES ;BARIUM ENEMA RADIOGRAPHY;COLONOSCOPY;CT SCANNING;TREATMENT;(1) Radical Colectomy;右半结肠癌切除范围;(2) With Acute Obstruction ;In Descending Colon ● 首先横结肠造瘘解除梗阻 ● 然后在充分肠道准备下手术切除;Chemotherapy;CARCINOMA OF RECTUM;● More than colon carcinoma (1.5:1) ● 60%~75% in lower rectum ● 10%~15% < 30 year old;(1) Direct Invasion to: wall of bowel, adjacent organ, such as: womb, prostate, bladder, seminalis, vagina, ureter … …;腹主动脉旁淋巴结;(B) 低位肿瘤向上方或者侧方转移 (C) 齿状线周围的肿瘤向上方、侧方 或者腹股沟淋巴结转移;(3) Hematogenous Spread ;(4) Implantation Metastasis;CLINICAL FEATURES ;DIAGNOSIS ;(4) 影像学检查 ● 结肠钡剂造影：评价有无多发瘤及定位 ● 腹部B超: 评价有无肝脏及腹腔淋巴结转移 ● 腔内超声: 评价中低位癌肿肠壁浸润深度 ● MRI检查：评价中低位癌肿肠壁浸润深度 ● CT 造影: 评价有无肝脏、腹腔淋巴结转移 及盆腔内的浸润情况 ● PET-CT: 评价有无远处转移及估测预后; (5) OTHERS: ● 腹股沟淋巴结活检, ● 阴道内诊或者腹部双合诊 ● 膀胱镜检查;TREATMENT;(1) 局部切除 Local Resection: suitable for early stage, with a small size, located in mucosa ● 经肛门局部切除术 ● 骶后径路局部切除术;（2）腹会阴联合直肠癌根治术 既往—金标准手术;Dixon Operation: suitable for tumor over 5cm apart from anus;(4) 经腹直肠癌切除、近端造口、远端封闭手术;● 后盆腔脏器清扫 （Posterior Pelvic Exenteration） radic